Active NPI
Kroger Texas L P
Doing business as Kroger Pharmacy
- Community/Retail Pharmacy
- League City, TX
National Provider Identifier
1770656290
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 22213
- Legal business name
- KROGER TEXAS L P
- Doing business as
- Kroger Pharmacy
- Practice address
- 250 S Egret Bay Blvd
League City, TX 77573-2682 - Phone
- (281) 332-2551
- Fax
- (281) 554-9032
- NPI assigned
- Nov 15, 2006
- Last updated
- May 16, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | 22213 | TX | Primary |
Addresses
Primary practice location
250 S Egret Bay Blvd
League City, TX 77573-2682
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2097570 | Other | PK | |
| 465502 | Medicaid | TX |
Other names 1
- KROGER PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041103001304 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 9638131303 | This NPI is an additional NPI on the enrollment |
| O20100930018806 | TX | DME Supplier - Pharmacy | 9638131303 | Practice locations: League City, TX |
National Provider Directory
National Provider Directory- Tax ID family
- Kroger Texas
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Kroger Pharmacy
- Community/Retail Pharmacy
- Pickerington, OH
- NPI 1245255967
Member Of
Locations
250 S Egret Bay Blvd
League City, TX 77573
Phone (281) 332-2551
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- League City, TX
- NPI 1780215590
-
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- League City, TX
- NPI 1437758729
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1463356800000",
"number": "1770656290",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 842772",
"city": "BOSTON",
"state": "MA",
"postal_code": "022842772",
"telephone_number": "513-762-1019",
"fax_number": "513-762-1092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 S EGRET BAY BLVD",
"city": "LEAGUE CITY",
"state": "TX",
"postal_code": "775732682",
"telephone_number": "281-332-2551",
"fax_number": "281-554-9032"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KROGER TEXAS L P",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-15",
"last_updated": "2016-05-16",
"status": "A",
"authorized_official_last_name": "MUENNICH",
"authorized_official_first_name": "ALLISON",
"authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
"authorized_official_telephone_number": "513-762-1019"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "22213",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2097570",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "465502",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "KROGER PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in League City, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.